Abstract:

Recurrent cervical cancer with spontaneous vesicoenteric fistula formation is extremely rare. Its clinical presentation is insidious and easily confused with radiation- or inflammation-induced fistulas. We report a 52-year-old female who presented with painless gross hematuria more than one year after radical hysterectomy for cervical cancer. Imaging revealed a right pelvic wall mass invading the bladder and ileum, along with multiple metastases in the retroperitoneal, mediastinal, and left supraclavicular lymph nodes. PET/CT showed air within the bladder. Combined with CT and MRI findings, a vesicoenteric fistula was strongly suspected. After admission, the patient underwent bilateral internal iliac artery embolization for hemostasis followed by laparoscopic exploration, which confirmed a 5 cm-diameter fistula between the ileum (130 cm distal to the ligament of Treitz) and the posterior bladder wall. One-stage surgery comprising partial small-bowel resection, bladder repair, sigmoid colostomy, and percutaneous nephrostomy was performed. Postoperative pathology confirmed metastatic poorly differentiated squamous cell carcinoma. Immunohistochemistry showed a programmed death-ligand 1 (PD-L1) combined positive score (CPS) of 5 and epidermal growth factor receptor (EGFR) (3+). After surgery, the patient received Serplulimab combined with albumin-bound Paclitaxel plus Carboplatin, and imaging evaluation indicated tumor shrinkage with stable disease (SD). This case highlights that unexplained hematuria or fecaluria in advanced cervical cancer should raise suspicion of a neoplastic complex fistula. Early surgical intervention combined with individualized immunotherapy combined with chemotherapy can rapidly relieve symptoms and control disease, providing a reference for the comprehensive management of similar critical cases.

Key words: Uterine cervical neoplasms, Carcinoma, Vesicoenteric fistula, Recurrence, Immunotherapy, Serplulimab